A Unique Child: Nutrition - Sweet talk

Sugar in food is the subject of much confusion among practitioners and parents alike. Most of us know that too much sugar can lead to tooth decay. But what 'sugars' are there? What types should we avoid? And what should we look out for on food labels?

WHAT KINDS OF SUGARS ARE THERE?

All sugars are carbohydrates and occur naturally but, by the time they reach our tables, some remain unprocessed, such as the sugars in honey or fresh fruit, while others are refined, as in the case of table sugar. When we talk about 'sugars' in our diet, we need to consider three types. 'Intrinsic sugars' form part of the natural cellular structure of food, for example, those found in fruit and vegetables, and include glucose, fructose, sucrose and dextrose. Sugars also occur in milk, and though not part of the cellular structure, these are described as 'milk sugars' and include lactose. Any sugar that does not occur naturally within a food is called a 'non-milk extrinsic' (NME) sugar, such as caster sugar. As sugars such as fructose, sucrose and glucose are commercially available in liquid or powder form, these can fall within the NME category as well as the intrinsic.

WHAT KIND OF SUGARS SHOULD CHILDREN AVOID EATING?

NME sugars are the ones that should concern early years providers most. These are the ones that we might add to our baking and puddings at home and will certainly find in processed products like biscuits, sugary breakfast cereals, cakes and soft drinks.

Current evidence suggests that too much food and lack of exercise, rather than sugary food alone, is the major cause of childhood obesity. However, refined sugars have little nutritional value and young children eating a high-sugar diet are likely to develop a sweet palate, which could lead to unhealthy eating habits, and obesity, in later life. The immediate, and significant, concern for young children is tooth decay.

NME sugars cause acids to form within the mouth and these attack the enamel of the teeth for at least 20 minutes after the sugar has been eaten. One of the best ways to reduce the risk of dental caries in young children is for settings to limit sugar consumption to mealtimes and to provide only savoury food, along with milk and water, at snack time.

Though popular with settings, practitioners also need to be aware of the risk of dried fruit to children's dental health. The drying process changes the cellular structure of the fruit, concentrating the sugar and leaving it 'free' to stick to children's teeth in the same way as sweets do. All dried fruits, like raisins, mango and apricots, should, therefore, be avoided at snack times and eaten either in a cooked dessert or after a main meal, as a pudding.

DO YOUNG CHILDREN NEED TO HAVE SUGARS IN THEIR DIETS?

As sugar occurs naturally in many foods, a child who consumes a wide and varied diet will invariably consume a certain amount of sugars.

Children under five require nutrient-dense food for growth, particularly within the first two years of life, so intrinsic and milk sugars can have a role to play in increasing children's energy without increasing bulk.

There are Dietary Reference Values (DRVs) for NME sugars. However, the DRVs define a level that should not be exceeded, rather than a level that should be reached to maintain good health.

Both Eat Better Start Better, by the School Food Trust, and Eating well for under-5s in childcare, the nutritional guidelines published by The Caroline Walker Trust, say that the contribution of NME sugars to the diet of pre-school children should be no more than 11 per cent of total food energy.

According to the latest National Diet and Nutrition Survey, the contribution for children aged one and a half to three years now stands at 11.8 per cent, significantly lower than that found in earlier Department of Health surveys, which put SME intakes at 18 per cent of total food energy.

ON FOOD LABELS, WHAT DOES 'CARBOHYDRATES - OF WHICH SUGARS' MEAN?

A typical example would be: carbohydrate 10.4g (per 100g), of which sugars 2.0g (per 100g). As mentioned above, sugars are carbohydrates, so the label is giving first the total amount of carbohydrates followed by the amount of carbohydrate that is actually sugar in every 100g.

The sugars figure will include all intrinsic, milk and NME sugars, so closer examination of what is contained in the food may be necessary. As the NHS Livewell website points out: 'A food containing lots of fruit or milk will be a healthier choice than one that contains lots of added sugars, even if the two products contain the same total amount of sugars. You can tell if the food contains lots of added sugars by checking the ingredients list.'

You can also be guided by the traffic light labelling system now used on some pre-packed foods: more than 15g of total sugars per 100g is high; 5g or less of total sugars per 100g is low.

WHAT ABOUT USING ARTIFICIAL SWEETENERS IN NURSERY FOOD?

Aspartame (E951) is widely used to sweeten soft drinks, yogurts and desserts, and 'sugar-free' varieties may contain this and Saccharin (E954) or Acesulfame (E950). Artificial sweeteners have been tested rigorously, both in the UK and by the Food and Drug Administration in the US. They are, therefore, safe to use and can be useful for people who are 'watching' their weight.

However, early years providers should be discouraged from using sweeteners as they contain few nutrients and young children need nutrient-dense foods that give them lots of energy. Also, there is some evidence that people who regularly use artificial sweeteners in their diet can develop a preference for high fat and sugar foods.

HOW DO YOU ENSURE ENOUGH GOOD SUGARS IN A CHILD'S DIET?

If a child is eating a full and varied diet, there should be no concern about how much sugar they are eating. In order to keep a check on the sugar intake of young children, the following is good advice:

• Restrict sugar to mealtimes to protect children's teeth.

• Offer only milk and water between meals.

• Offer only sugar-free or savoury snacks between meals.

• Always offer a savoury course before a sweet course.

• Puddings can form part of a healthy diet. A healthy pudding is milky, such as custard, or fruit based, for example, apple crumble. It is acceptable to add a little sugar in the case of tart fruits such as rhubarb and gooseberries.

• If you find you are confused by the labelling on food or the kind of sugars within a food, then go for savoury options.

Prepared with the help of Emma Cronly-Dillon, who heads a team of Bedfordshire-based dietitians who deliver training and set nutritional targets for childcare providers involved in the Healthy Under 5s Award (see www.under5shealthyeatingaward.nhs.uk)

CASE STUDY

The best way for early years settings to control the amount of sugar that goes into a child's diet is to cook everything from scratch, says public health nutritionist Annie Seely.

She has witnessed early years settings use innovative ways to reduce sugar intake by relying on fruit-based puddings.

She says, 'Having a pudding after a main meal doesn't increase insulin levels to the same extent as sweet treats between meals, because if it is eaten after a main meal, the release of sugars into the blood is slowed down.'

She recalls visiting Tootsies Day Nursery in Farnham, Surrey, where chef Tristian Strover had managed to reduce the amount of sugar in a cake that he made by 38 per cent, by adding vegetables and dried fruit (see recipe, right).

Mr Strover says, 'Something you may not expect is the high level of sugars often found in tinned products of tomato sauce and breads.

'We reduce the children's sugar intakes by recreating favourites such as baked beans and by baking our own bread products where possible.'

MORE INFORMATION

• Eating Well for Under-5s in Childcare - practical and nutritional guidelines, Caroline Walker Trust, www.cwt.org.uk

• Eat Better Start Better - voluntary food and drink guidelines for early years settings in England: www.schoolfoodtrust.org.uk

• National Diet and Nutrition Survey - headline results from years 1, 2 and 3 (combined) (2008/09-2010/11), www.natcen.ac.uk

• www.nhs.uk/Livewell/Goodfood/Pages/sugars.aspx